Which clients would the nurse evaluate as unsuitable for the ...

[kamilo84]

Which clients would the nurse evaluate as unsuitable for the administration of fentanyl as anesthesia?
 
  Standard Text: Select all that apply.
  1. A 60-year-old with history of emphysema
  2. A 17-year-old who sustained a head injury in a motor vehicle accident
  3. A breast-feeding mother
  4. A 58-year-old with type 2 diabetes mellitus
  5. A 70-year-old with a history of ulcerative colitis

Question 2

A client has had an unexpected reaction to propofol (Diprivan) and may be developing propofol infusion syndrome (PIF). What assessment findings are important for the nurse to relay to the client's health care provider?
 
  Standard Text: Select all that apply.
  1. The client's urinary output has fallen to almost nothing over the last 4 hours.
  2. The client's urine is cola-colored.
  3. The client's serum potassium level drawn an hour ago is low normal.
  4. The client is complaining of right upper quadrant pain.
  5. The client has a fever.

[cassie_ragen]

Answer to Question 1

Correct Answer: 1,2,3
Rationale 1: Any client with a history of respiratory impairment should be administered fentanyl only with great caution.
Rationale 2: Clients who have sustained head injury should not receive fentanyl.
Rationale 3: Fentanyl is secreted in breast milk and should not be given to breast-feeding mothers.
Rationale 4: There is no contraindication to fentanyl administration for this client. If the client has renal impairment from diabetes, a lower dose might be given.
Rationale 5: While age is not a contraindication for administration of fentanyl, the nurse would take special fall risk precautions with this client.
Global Rationale: Any client with a history of respiratory impairment should be administered fentanyl only with great caution. Clients who have sustained head injury should not receive fentanyl. Fentanyl is secreted in breast milk and should not be given to breast-feeding mothers. There is no contraindication to fentanyl administration for the client diagnosed with diabetes mellitus. If the client has renal impairment from diabetes, a lower dose might be given. While age is not a contraindication for administration of fentanyl, the nurse would take special fall risk precautions with the 70-year-old client.

Answer to Question 2

Correct Answer: 1,2,4
Rationale 1: This could be a sign of renal failure, which is a sign of PIF.
Rationale 2: This can be a sign of liver problems or rhabdomyolysis, which are both associated with PIF.
Rationale 3: One of the findings associated with PIF is hyperkalemia, not hypokalemia.
Rationale 4: Pain in the right upper quadrant may be pain from the liver. Liver enlargement is associated with PIF.
Rationale 5: Temperature elevation is not associated with PIF.
Global Rationale: Decreased urine output, cola-colored urine, and pain in the right upper quadrant are all signs of PIF. One of the findings associated with PIF is hyperkalemia, not hypokalemia. Temperature elevation is not associated with PIF.

[kamilo84]

Excellent

[Liddy]

Gracias!